High BMI: To Use Or Not to Use Modifier 22
The new fifth-digit diagnosis codes for body mass index (BMI) can help you better document a patient’s condition, especially when the patient’s BMI might contribute to more complex risk factors for the anesthesiologist to handle. Having documentation of a high BMI doesn’t automatically lead to more pay, however. Watch two areas before assuming you can automatically append modifier 22 (Increased procedural services) because of BMI and potentially score a 20-30 percent higher pay for the procedure.
Not All Morbid Obesity Means Modifier 22
A patient is considered to be morbidly obese when his or her BMI is 40 or more. New BMI codes for 2011 include:
- V85.41 — Body Mass Index 40.0-44.9, adult
- V85.42 — Body Mass Index 45.0-49.9, adult
- V85.43 — Body Mass Index 50.0-59.9, adult
- V85.44 — Body Mass Index 60.0-69.9, adult
- V85.45 — Body Mass Index 70 and over, adult.
While morbid obesity can be an appropriate reason to report modifier 22, don’t assume you should always append the modifier just because the patient is morbidly obese.
Example 1: During surgical procedures that are performed because of morbid obesity (such as bariatric surgery), the patient must meet the morbidly obese criteria too support medical necessity for the procedure. In those type instances, simply having a patient who is morbidly obese doesn’t support using modifier 22. Remember, if you report a physical status modifier for a patient who is morbidly obese, it is not appropriate to also include modifier 22. Keep in mind that Medicare does not pay for physical status, qualifying circumstances, or extra work modifiers.
The anesthesia provider’s documentation should direct you to the correct BMI code as well as support when you can append modifier 22.
Example 2: The patient’s obesity might contribute to breathing problems that lead to lower oxygen and...